Waiver and Release Form
I certify that my child is in good health and can participate in the daily activities of the Montessori of Acadiana Summer Program unless otherwise notified.
I understand that the students will be under the care and supervision of the teacher(s) and other staff members. I hereby designate and authorize these persons to be responsible for my child. If medical care is required for my child, I authorize MOA teachers and staff members to: a) provide first aid and secure medical assistance for my child’s benefit, b) authorize any doctor, hospital, or other medical service provider to provide emergency medical treatment for my child without my further consent, and c) give or authorize non-emergency treatment to my child. I agree to pay for any such emergency or non-emergency treatment, and I hereby release and hold harmless Montessori of Acadiana, its agents and/or employees, from any and all liabilities arising from the administration of first aid and from the rendering of medical services by any doctor, hospital, or other medical service provider(s).
I know that the summer program enrollment is done on a first come, first served basis. If space is not available, my child may be placed on a waiting list. I understand that MOA reserves the right to cancel any week if a minimum enrollment is not reached. In this case, full refunds will be made. I am aware that if a student is withdrawn for any reason after June 1st, tuition & application fees will not be refunded. Deposits are non-refundable at any time.
I hereby release and hold harmless Montessori of Acadiana and its employees, agents, officers, and principals, from all claims, losses, liability, and expense, of whatever nature, whether for personal injury or property damage, and including litigation costs, attorneys’ fees, and other expenses and costs, which I and/or my child may have, which arise from or relate in any way to the programs at Montessori of Acadiana, to the extent such claims may be waived under Louisiana law, which governs this document.
I understand and have explained to my child that participation in Montessori of Acadiana’s program is a privilege and that she/he must follow MOA rules and policies, as well as directions given by teachers and other staff members. I understand that failure to do so may result in arrangements being made for my child to be sent home and/or removed from the Montessori of Acadiana summer program completely.
I acknowledge that I have read the foregoing document, that I have legal authority to sign it as the parent/guardian of my child named above, and that this is an Authorization and a Release of Potential Claims.
Montessori of Acadiana will take photos of students at school while they are working to update parents on their child's progress and daily activities. If agreed upon in the student information form, the student’s name, photograph, voice, image, and information may be used by the school for use in the school’s publications, promotional materials, social networks, and website without compensation and without prior notice. This also applies if students are to be interviewed by the media on campus or at school-related events. Montessori of Acadiana will not be held liable for any issues stemming from the use of the student’s name, photograph, voice, image, or information.